Dry mouth. High heart rates. Cold feet (and other extremities). Headache. Aerophagia (air in the tummy) while using CPAP. Cramping in the legs and feet. Any or all if this often with an awakening. Amongst the thousands of posts I have read on the Sleep Apnea forums these symptoms appear most often as complaints.
And I have dealt with all of them.
But one I have rarely dealt with is “not being able to get enough air” during the going to sleep process with CPAP. The mystery – CPAP means “Continuous POSITIVE Airway Pressure”. In other words the pressure at the nose (and possibly mouth as well) is higher than the air in general. It must be EASIER to get a normal amount of air. So what causes this inordinate air hunger?
Well ventilatory instability is common in the literature about CPAP. And it has been posited that a separation in the blood supply between the peripheral chemoreceptors (blood gas sensors away from the brain) and central chemoreceptors (blood gas sensors within the brain) might well be the cause of such instability. Indeed this does seem to be the case with me.
I believe this is true because regular neck exercise (and other anti-arthritic strategies) along with the correction of forward head posture makes my tendency to over breath go away apparently by quenching the inordinate air hunger. Anymore if my nose gets stuffy I correct my head posture my breathing normalizes (it was too much) and the nose clears.
But where does all of this likely come from? I think the answer can be found by looking at how the brain stem gets its necessary blood supply.
The brain stem is the major signal distribution center of the brain. The cranial nerves stem from there and many may well play a part with sleep apnea such as:
– airway and salivation control (cranial nerve IX Glossopharyngeal) [apnea and dry mouth]
– tongue control (cranial nerve XII Hypoglossal) [postural apnea]
– Blood pressure, breathing, and aspects of digestion (Vegas Nerve (X)) [Respiratory control system gain. Blood pressure. Heart rates. Gastroesophageal reflux disease (GERD)? Arousal threshold (but probably elsewhere in the brain stem)? Aerophagia (air in the tummy)?]
– Biting and chewing (Trigeminal V). [Teeth Grinding (Bruxism)]
But indeed the central chemoreceptors (blood gas levels sensors) are in the brain stem and failing to supply the brain stem with enough good blood, for me, does indeed result in more breathing and higher heart rates.
The blood supply to the brain stem (basilar artery) is supposed to be redundant with parts of the Circle of Willis, specifically the Posterior Communicating Arteries, being involved. However in half of us the Posterior Communicating Arteries are simply lacking. But the brain stem is simply critical so its main blood supply comes alongside (more or less threaded through and protected by) our neck vertebrae by way of the Vertebral Arteries.
But what if there is inflammation in and around those vertebrae? When I first started my neck exercises I could hear and feel a lot of snapping and popping as I did them. Arthritic inflammation involved?! And when the snapping and popping did occur then there was a feeling of relief. So in my case I do believe inflammation is part of this story.
But often I find that stress brings symptoms even during the daytime. And I do remember many many tension headaches that I did have. And that if I could get the “rock hard” neck muscles to relax the headache would also go away. Perhaps if you compress the vertebra with excessive muscle tension there is less room to transport blood in the vertebral arteries?
But what if you slump the whole vertebral stack forward with forward head posture? Indeed with a consistency that amazes me correction of my forward head posture quenches my tendency to over breath and all of the symptoms associated. I remember on the forums that some had been given a cervical collar and had a better experience with CPAP use. Perhaps the correction of forward head posture (I find myself tending to do this even in bed) is why this was working for them?
So apparently a lack of blood from the Circle of Willis and an intermittently compromised Vertebral Artery path result in breathing and blood pressure increases as the brain stem holds both sensors and the signaling supplies for these systems. Since the rest of the body is likely to be at rest a normal level of carbon dioxide will not be maintained. When carbon dioxide levels get too low circulation especially in the brain diminish. The blood supply problem to the brain stem (and now the rest of the brain) would likely get worse from that. While I did use the term “inordinate air hunger” to indicate what is likely this condition perhaps the body does know best. The thing is we must have blood to the brain stem. That said I have found eucapnic breathing techniques during the daytime and EERS at night using CPAP helpful likely because they deal with the carbon dioxide maintenance issues.
But over all so far the neck exercises along with the other things done to control inflammation and arthritis in my neck along with the correction of forward head posture do seem so far more effective to eliminate breathing instability.
There is one more thing I have recently discovered that seems to help not only the breathing issues but also a tendency to have trouble getting to sleep and staying to sleep as well. I take three heaping teaspoons of activated charcoal in 14 oz of water just before bed time not eating for at least two hours before. I do not know why this works but it is amazingly consistent and since there are no known problems with activated charcoal, well, why not?
Steve said:
I have been trying to find a way to get in touch with you regarding Cpap carbon dioxide washout, over-breathing and how those relate to a higher AHI. Found some of your old posts on cpaptalk (those people need an attitude adjustment). Sadly they are spreading harmful misinformation. The place has gone to the Frogs!
I found by using 3M waterproof tape and a leather punch there is a simple solution. I cut two pieces of the 1 inch tape to about 1.25 inches long. Punch a 4mm hole in the middle of each. Clean the noise with soap and water or alcohol and apply the tape to seal each nostril allowing only the 4mm holes for breathing. I also have to tape my mouth completely shut since I am a serious mouth breather probably due to under saturation of Co2. This virtually removes any chance of over breathing.
My goto mask for this is the Wisp but it works well with anything other than pillows. (I also have a pillow method) My original pressure was 12.something and I would still have an AHI of 5 or above. With the above configuration I am now at auto 7 with a max of 8 with an AHI of ZERO or just barely above. My guess is my pressure could go a lot lower but have not tested that yet. Could be the above may end a need for a Cpap altogether – time will tell.
I have recently started using the Frolov device to increase carbon dioxide and CP. My current CP is 15, up from 10.
If you get my email with this post, please reach out to me – I want to know more about what you are doing to increase your nighttime Co2.
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todmerley said:
Hi Steve!
I just finished a slow (1mph) session on my treadmill while doing my neck exercises. These neck exercises, along with many other things that I am doing, do seem to be reducing the arthritis and inflammation in my neck. With more “room” provided to the arteries which are running along and somewhat threaded through the vertebrae in my neck the supply of blood to my brain stem (the place where some of the blood gas sensors are located) seems to be much more consistent. As a result I much less often see indications of ventilatory (breathing) instability in my breathing waveforms at night. As well I do not wake up over breathing near as often.
[Steve said] I have been trying to find a way to get in touch with you regarding Cpap carbon dioxide washout, over-breathing and how those relate to a higher AHI. Found some of your old posts on cpaptalk (those people need an attitude adjustment). Sadly they are spreading harmful misinformation. The place has gone to the Frogs![end quote]
Ah respiratory (breathing) control system gain and CPAP use. Probably what makes many abandon CPAP I suppose.
Cpaptalk is not the only one to be shilled, sockpuppeted, trolled, and astroturfed effectively I suppose. A sad day for the Internet and health.
[Steve said]I found by using 3M waterproof tape and a leather punch there is a simple solution. I cut two pieces of the 1 inch tape to about 1.25 inches long. Punch a 4mm hole in the middle of each. Clean the noise with soap and water or alcohol and apply the tape to seal each nostril allowing only the 4mm holes for breathing. I also have to tape my mouth completely shut since I am a serious mouth breather probably due to under saturation of Co2. This virtually removes any chance of over breathing.
My goto mask for this is the Wisp but it works well with anything other than pillows. (I also have a pillow method) My original pressure was 12.something and I would still have an AHI of 5 or above. With the above configuration I am now at auto 7 with a max of 8 with an AHI of ZERO or just barely above. My guess is my pressure could go a lot lower but have not tested that yet. Could be the above may end a need for a Cpap altogether – time will tell.[end quote]
I am not sure I understand all that you wrote here but I am glad you seem to have found a system that appears to be working for you now.
[Steve said]I have recently started using the Frolov device to increase carbon dioxide and CP. My current CP is 15, up from 10.[end quote]
I never did get around to making a Frolov device simple as that would be.
I do not use the Buteyko Breathing Technique and so do not check my Control Pause (CP). I have done a lot of pulse oximeter guided eucapnic breathing in the past, however, and seeing 96% SpO2 pop up on my pulse oximeter is always a great thing to see (at my current 2500′ ASL would like to see 97% at sea level). Knowing that my breathing is at reasonable rates for my present rate of metabolism is also greatly appreciated.
I chose to go the pulse oximeter guided path because I could see no real mechanism in Buteyko which would keep one from going too far. Yes hypocapnia (too little carbon dioxide in the blood) is bad because it both seriously reduces circulation and also reduces oxygen transport when loaded blood cells do get through. This is particularly true in the brain. But hypercapnia (too much carbon dioxide in the blood) is also to be feared due to great strain on the heart (it is pumping now into “spongey fire hoses”) high blood pressure, and whatever else happens when blood gets too acidic.
The real issue is why is the breathing control system out of whack!?
[Steve said]If you get my email with this post, please reach out to me – I want to know more about what you are doing to increase your nighttime Co2.[end quote]
Although I do maintain a form of EERS (noted in other posts here and in the title “Now Using Modified EERS”) my goal is not to have more CO2 at night. Rather my hope is that the respiratory control system (breathing control system) will properly control my blood gas levels as it should.
I am glad that I found pulse oximeter guided eucapnic breathing. I am glad and feel a bit safer using modified EERS. But I am most glad to have found the books[1-3] I am currently working with to improve my health.
I shall try to get it together to add a post about the neck exercises soon.
[1] http://www.amazon.com/Wahls-Protocol-Autoimmune-Conditions-Principles/dp/1583335544
[2] http://www.amazon.com/Disease-Delusion-Conquering-Chronic-Healthier/dp/0062290746
[3] http://www.amazon.com/Charcoal-Remedies-John-Dinsley/dp/0973846402
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Steve said:
Can you explain what you mean by “breathing control system”?
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todmerley said:
[Steve said:]
Can you explain what you mean by “breathing control system”?[end quote]
To maintain proper levels of oxygen and carbon dioxide in the blood you need to sense how much of those blood gasses are indeed in the blood at this time. This is kind of like how we use our hand to feel the temperature of the water when we take a shower. We need enough flow and enough of each kind of water to make a good shower. Our hand serves as the sensor in this case.
So in the carotid artery located under where the ear lobe hangs (well pretty close) this artery splits and at the top of the resultant ‘Y’ is a little lentil shaped organ we call the carotid body (one on each side). These are the peripheral (away from the center – away from the brain) chemoreceptors (blood gas level sensors). But note that the majority of the brain is fed from the “internal” branch of this artery.
At the base of the brain is the brain stem. It contains the many “central (within the brain) chemoreceptors”.
The central and peripheral chemoreceptors both contribute their information to, they believe, several structures in the brain stem which, after adding information from other sources, is used to determine the drive to the lung muscles (and heart and vascular systems as well). So how much we breath and indeed the “urge to breath” is determined using input from these sensors.
I believe that in my case circulation problems to the brain stem result in it sending strong signals to breath (and it does need the oxygen). However that much breathing washes out the carbon dioxide which closes down circulation and metabolism even further. Using some conscious control is helpful but the best thing is to restore good consistent circulation to the brain stem.
I was having trouble posting my previous response so it may have changed a bit.
I hope this is all helpful.
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Steve said:
To say the least you have my attention – “restore good consistent circulation to the brain stem”. Do any of your posts detail the instructions?
I don’t do Buteyko other than the Frolov Device which is quick way to achieve the same goal and approved by most Buteyko instructors. I adapted a Cpap nasal mask to it so I don’t have to mouth breath.
I would be very interested in knowing more about your program and what the exercises are.
The short answer to my nightly tape configuration is – it slows my breathing down dramatically. It makes involuntary sleep breathing way less turbulent which reduces the chances of sucking the airway closed. On SleepyHead software my respiration rate has dropped from high 17 to 18 to mid 15/16 per minute.
My inhales and exhales have increased by 1/2 second or more each. I got the idea after seeing an FDA approved device that reduces exhale but does not restrict the inhale. That seemed wrong to me since the inhale creates the suction and the exhale creates expansion.
You get plenty of air with 4mm holes from each nostril but you can’t get going enough to suck a moth out of the air. The taping prevents the vacuum that closes off your airway. It keeps your breathing quit through the night.
I definitely want to learn more about what you are doing and how you are doing it.
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todmerley said:
It is all about getting “room” in the neck.
So anything which would cause the vertebral stack to become compressed is to work on. I am thinking muscle tension here. And to counter I think mindfulness breathing techniques are helpful. But another cause of compression is forward head posture. For that I am walking about 4.5 miles a day average (well that is the goal – did so Feb and Mar this year). During that time I am also “keeping my head up” often concentrating on good posture with the head on the shoulders where it should be. Even as I sit and type this I am aware of posture. It is easy in this position to do the “forward head posture / upper cross syndrome” thing. It used to be almost painful to do correct posture. But things are better after doing it for some time.
Anything which would cause inflammation in the neck is to be worked on. So far I see:
Toxins!:
It is interesting that truck drivers have about seven times the rate of OSA as the rest of the population. I think part of that is all that time breathing road dust, side of the road treatments, exhaust fumes, and whatever makes it into the passenger compartment from the engine compartment. What I am doing to detox you can find in the books[1-3] I mentioned. It is a lot and I have just started this part of it all.
Please also note that applying an activated charcoal poultice to my neck resulted in about a day of extra pain. I kind of expected this. I think there may be a Lyme-like pathogen involved and getting some of the toxins out of the way I would think might well “unmask” their activity. After the time of discomfort things simply were considerably better. Much less “snapping and popping” (a sign of arthritis), more ease of movement, and much less problems with breathing control.
Neck exercise is likely to help with the toxins as well. Not only do you stimulate immune response but you are also moving things near the involved lymph nodes which have no real way to move themselves and rely on our moving to get the job done. I keep thinking about my need to self massage in the neck areas especially near the lymph nodes.
The books contain a whole lot more information about detox. I do highly recommend them.
Eating Well / Moving Well :
I have done a lot already working with a dietitian and personal trainer. I have lost 55 pounds over about six years doing what I have been doing. But the books contain some strategies I was unaware of (or just becoming aware of). The need to “change out” my gut flora is one mentioned by two of the books [1,2]. But I will likely use a program outlined in another[5]. Much of my inflammation issues do appear to stem from my gut. Learning what foods I am sensitive to will be a part of this.
I will be working with a personal trainer shortly to learn exercise to specifically move away from forward head posture as well as other things.
Doing the right amount and type of exercise for your specific body will very much help stave off inflammation. This is why we need good personal trainers.
See the Sun a Bit:
You should respect the Sun and how it can harm you. Enough I do believe to “inoculate” yourself as humans have done for many thousands of years. My skin tans very well and always has. But now over 60 I stay out of it if the UV index is above 8 and temper my exposure otherwise to prevent any pinking ever. By doing so I provide not only vitamin D3 (see: https://www.vitamindcouncil.org/ ) but also many other things making a kind of super quick repair kit for the body to use as needed – which tends to keep inflammation down.
Still working on the neck exercise post.
[1] http://www.amazon.com/Disease-Delusion-Conquering-Chronic-Healthier/dp/0062290746
[2] http://www.amazon.com/Wahls-Protocol-Autoimmune-Conditions-Principles/dp/1583335544
[3] http://www.amazon.com/Charcoal-Remedies-John-Dinsley/dp/0973846402
[4] http://www.amazon.com/Starwest-Botanicals-Charcoal-Powder-Activated/dp/B0081P1ENS
[5] http://www.amazon.com/Microbiome-Diet-Scientifically-Restore-Permanent/dp/0738218111
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Steve said:
How does charcoal fit in. I’ve read now that it can promote sleep and it’s assumed that the reason is from its detoxifying value. However it’s also mentioned that charcoal comes with a risk if used a lot such as removing nutrients and possibly the useful chemicals from gut bacteria.
I’ve ordered the book you referenced on charcoal. Is there anything in it or that you can share that will make the regular use of charcoal sound less risky???
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todmerley said:
I do have concern that regular use of activated charcoal might well affect nutrient absorption/production. The book does mention an experiment where mice were found to live 1/3 longer if fed activated charcoal constantly. In my case getting to sleep easily and staying to sleep consistently and seeing better numbers and results from CPAP use is what constantly brings me back to this. Some of my symptoms of late would indicate mild organophosphate poisoning so making less those toxins in my blood stream may be part of why it works with me. But as I mentioned I believe I need to change out my gut flora and so I am suspicious that the reduced growth rates and adsorption of toxins produced by the bugs living in my gut overnight is likely the most possible reason why this works for me. Since I do strive for Dr. Wahls “nine cups a day of veggies and fruit a day” along with lots of water I hope the constant clearing of the charcoal keeps things working well.
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todmerley said:
Steve please also note the new neck exercise entry.
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Steve said:
Hey todmerley – it’s been about a year, hope all is well in your world. Using the tape configuration I mentioned last year I have been able to get my AHI from 13 down to 4. Could probably go without the CPAP but just haven’t had the guts. I have not tried the vent system to increase Co2 but do use dust masks during waking hours to increase Co2 tolerance. I would be more prone to do it if there was a simple way to add to the mask rather than alter it. Again – hope all is well in your world…
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todmerley said:
Hi Steve!
My ventalatory stability issues while using CPAP are now better tamed by exercise (c/o the articles referencing neck exercise here). In my case it seems that my posterior communicating arteries are lacking or non-existent and my vertebral arteries seem to be intermittently compromised by inflammation and/or tense neck muscles (both likely stress related). Eucapnic breathing and meditative “following the breath” are helpful to move the CO2 levels back up and so promote better circulation – and – as soon as the basilar artery has a sufficient supply of usable blood the ventilatory control sensors in the base of my brain quiet things down and resume normal operations. Anymore simply correcting my forward head posture upper cross syndrome will bring my breathing back in line.
To put it another way the blood flowing through the vertebra in my neck supply the sensors in the base of my brain which control breathing. So the neck exercise sets the neck in better posture and reduces inflammation making for a better supply of blood to the base of the brain and so better control of breathing. The base of the brain is a critical “switching center” for brain to body and back signals so supply to it is critical and as it controls breathing it causes it (and blood pressure) to increase to try to keep itself in good order. However if too much CO2 is lost circulation in the brain tends to shut down.
CPAP is simply a bit of a splint. EERS is only, in my thinking, for temporary use if truly needed.
If you want to get better I recommend “The Disease Delusion” by Dr. Jeffery S. Bland. Functional medicine moves one better toward true health.
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